There's no silver bullet, which is why I tend to focus on a number of areas that might combine to make a difference to the deficit. Patent prescription drugs for Medicare is just one line item.

If GDP is ~$15T and health care expenditures in the US are ~16%, then we spend ~$2.4T on health care each year. If pharmaceuticals are 10%, that amounts to $240B. If Medicare accounts for $120B/year (an estimate I found over at the Washington Post) and a generics-only policy could save 50% of the total cost (a conservative estimate), the savings would be $60B/year.

Rob S, people focus on symbolic issues because it's more fun to take a stand against "unnecessary profit taking" by pharmaceutical companies and insurance companies (whose profits amount to a tiny, tiny percentage of U.S. healthcare spending), than rail against the heavy utilization of healthcare services by elderly Americans (which is the real cause of most of American healthcare spending). I'm not a fan of Big Pharma or American private health insurers, but if you do the math, it's hard to blame them for *everything.*

That being said, you are correct that pharmaceutical drugs are only 10% of U.S. healthcare spending. However, saving money on 10%, while nowhere near good enough to solve our fiscal problems, does help a bit, especially since with the Republican-passed Medicare Prescription Drug benefit, us taxpayers are on the hook for prescription drugs.

The train is still without a conductor, as there is no plan to raise taxes, cut defense spending, and reform entitlements. It is pathetic to see the leadership of an empire arguing over the carpet color when the house is burning.

Wordwell wrote: "America has become the kind of country where university students studying Accounting and Finance are now required to take courses on fundamentalist female reproductive theology as part of their core curriculum."

As an undergraduate student 3 years ago, I had a roommate majoring in Accounting and Finance who is now earning the big bucks working for Citi Bank.

For those of you several years removed from college who agree with Wordwell and fret for the future of America's accountants, I want to assure you that my financier roommate managed to graduate with honors with a degree in Accounting and Finance despite having never taken "Fundamentalist Female Reproductive Theology 101."

There is a "Humanities" requirement at many colleges, but motivated young men can avoid taking "Fundamentalist Female Reproductive Theology 101" by instead choosing "Introduction to Logic" and "Works of Shakespeare" to fulfill that humanities requirement. Just thought you old-timers who heard stories from your drinking buddy's son-in-law about college requirement these days should know that the stories of mandatory Pro-Abortion re-education classes being required of engineering majors are untrue.

People keep rattling on about symbolic issues. The cost of drugs is an example. It only makes up, in total, 10% of the total spent on medical care in the US, yet Heimdall et all spend 90% of their time telling us how we can reduce it. So we cut it by 10%? 50%? So what?

Do you REALLY want to cut the money spent on medical care? Cut the amount available. Dumping more money into the hopper is what expanded the costs.

Imagining a Ron Paul presidency is fun. He'd bring all the troops home which will save a lot but not enough. He'd veto everything that doesn't cut spending. In normal times, you could just load bills up with enough pork until you get the votes to override a veto but these aren't normal times. So you'll really get no more new spending. So long as the Democrats control the Senate, you won't get any deep cuts either. We'll still have a deficit.

The Senate would reject many of Paul's nominees leaving courts emptier and agencies and the Fed maintaining the status quo. In the end, domestically, government won't be that different under a Paul presidency.

I am not an american so I am not emotionally invested on this. Nevertheless, can someone explain to me how is it that republicans claim to be the fiscally responsible party while the llast time they had the presidency they turned the federal surplus they received into a deficit, by cutting taxes, doing nothing about entitlements, while raising both military and nonmilitary discretionary spending?

Raising the marginal tax rate on income over $100,000 to 50% will not close the deficit. Eliminating DoD will not close the deficit. That leaves only two options: Raise taxes on the middle class or cut non-military spending. You're not allowed to complain unless you pick at least one of those options.

Because nobody wants to argue that middle-class taxes should be raised.

"* Most of it is military spending equal to the next 17 countries combined. Pretty excessive."

No most of it is entitlements.

"* Also poorly designed government expenditures on health care. For instance, a prescription drug plan that prohibits price negotiation? Insane!"

That's not negotiation. The government, as a monopolist, would set prices for many drugs.

"* Do we really need to imprison more citizens than any other country?"

That's more of a state problem.

"* Do hugely profitable oil companies really need subsidies?"

Everyone overuses "subsidy." The government leased land to oil companies. Some want the government to break the contracts and force oil companies to pay more (not unreasonable IMO). The failure to do that is what some are calling "subsidies." But anyway, this is peanuts.

You're correct that the Dems blew a chance to exert more influence back when they controlled both Houses. But that doesn't mean that they must concede that the deficit is purely a function of berserk discretionary spending.

When revenues as a percent of GDP are at 60-year lows, a very credible case can be made that revenues are a significant part of the problem.

For 2011, estimated revenues are 14.4% of GDP. The average over the last 60 years is 17.8%. Estimated GDP for 2011 is $15T. Simply reverting tax policies to the mean would slash the deficit by some $500B.

Why are no Democrats making this very simple argument? The fiscal responsibility of this move would dwarf anything that the Republicans are proposing.

Sure, we spend too much.

* Most of it is military spending equal to the next 17 countries combined. Pretty excessive.

* Also poorly designed government expenditures on health care. For instance, a prescription drug plan that prohibits price negotiation? Insane! Keep it to generics and 86 the subsidy to the pharmaceutical industry.

* Do we really need to imprison more citizens than any other country?

* Do hugely profitable oil companies really need subsidies?

So yeah, we need to work on spending. But Dems have a powerful revenue argument to make and they're leaving that tool totally unused.

Theodosius West wrote: Apr 9th 2011 11:54 GMT "This is what defeat tastes like, Democrats. Get used to it because you and this clueless president are going to be eating a steady diet of it before you're finally sent packing in 2012.

Open wide!"

Not if moderate and centrist disestablishmentarian voters like myself have a say in it.

Bend over!

Clave32 wrote: Apr 9th 2011 2:22 GMT "Sick of Republicans yet?"
I have been for some time. The problem is that the Democrats are only somewhat less corrupt, somewhat less blatantly in the pockets of the corporations, and less ideological.

My biggest beef with the GOP is that they force me to vote for the Democrats as the least bad alternative. We really need a new anti-corruption party to clean out the Augean stable that is modern Washington!

chernyshevsky wrote: Apr 9th 2011 4:51 GMT "While it disappointing that we didn't get the $100 billion the Republicans promised, $38 billion out of around $700 billion worth of non-defense discretionary spending is not insignificant. This scrimmage is a prelude to the larger battle that is entitlement reform. Though our victory is not decisive, the enemies are in retreat."

Really? I hadn't heard that the Pentagon was in retreat, much less the K Street Lobbyists and the fat cat bankers. Until these enemies of the republic are neutralized we remain in grave danger.

America has become the kind of country where university students studying Accounting and Finance are now required to take courses on fundamentalist female reproductive theology as part of their core curriculum.